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UNITED STATES OF AMERICA. 



THE TREATMENT 



OPIUM ADDICTION 



BY 






f. b.'mattison, m.d. 

Member of the American Association for the Cure of Inebriates ; of the New York Neurological 
Society; of the Medical Society of the County of Kings, etc., etc. 



1 V ry 

X 



V 




NEW YORK & LONDON 

G. P. PUTNAM'S SONS 

®(jt fjtridurbcclur |)kss 
1885 



COPYRIGHT BY 

J. B. MATTISON, M.D. 

1885 



Press of 

G. P. Putnam's Sons 

New York 






(& 




TO 

JOSEPH PARRISH, M.D. 

OF 

BURLINGTON, N. J. 

WHO FIRST DIRECTED THE WRITER'S ATTENTION TOWARDS THE WORK TO WHICH HE 

IS DEVOTING HIS PROFESSIONAL LIFE, THIS LITTLE BOOK — WITH THE 

HIGHEST ESTEEM — IS MOST CORDIALLY INSCRIBED BY 

THE AUTHOR 



PREFACE. 

This monograph is — mainly — a paper pre- 
sented to the American Association for the 
Cure of Inebriates at its last annual meeting, 
October 22, 1884, and details a method of 
treatment original with the writer, and practised 
by him for several years with increasing satis- 
faction and success. 

Brooklyn, N. Y., 
314 State St., June I, 1885. 



THE TREATMENT 

OF 

OPIUM ADDICTION. 



Several years have passed since the writer 
had the pleasure of reading before this society 
a paper on the subject of opium addiction. 

During this time his professional attention 
has been largely, and, of late years, exclusively 
devoted to the study and treatment of this 
toxic neurosis, and, with increasing experience 
has come improved therapeutics, all of which 
warrant him in again inviting attention to a 
topic that, though accorded but little thought 
by the profession at large, possesses a great 
and growing importance, the extent of which, 
perhaps, will be none the less appreciated by 
the reflection that many of those who fall vic- 
tims to its steady advances are recruited from 
the ranks of our own confreres. 

Opium addiction is a disease, a well-marked 



2 THE TREATMENT OF OPIUM ADDICTION. 

functional neurosis, and deserving recognition 
as such to a greater degree than it has hitherto 
received. In the vast majority of cases the 
vice theory of its origin is incorrect, so that, 
with few exceptions, the term "opium habit" 
is a misnomer, implying, as it wrongly does, an 
opiate-using quite under individual control. 

As elsewhere stated, " The Genesis of Opium 
Addiction," Detroit Lancet, Jan., 1884, two 
causative factors exist — necessity and desire, — 
but the result, if the opiate be sufficiently long 
continued, is essentially the same — a condition 
of disease, as evidenced by various functional 
ills. 

The central tracts involved are the cerebro- 
spinal and sympathetic systems. Deviations 
from health noted are due to departure from 
the normal tone of one or both of these centres. 
Organic lesions are rare — possibly some instan- 
ces of renal or brain disease, — the usual ultimate 
result being a state of marasmus — impaired 
nutrition, and profound nerve depression — end- 
ing in death. 

In the paper to which reference has been 
made, attention was invited to a new method 
of treatment, and as this is largely the same 
we now employ — some improved changes will 



THE TREATMENT OE OPIUM ADDICTION. 3 

be noted in passing — we re-assert that it is 
based on the power of certain remedial resources 
to control abnormal reflex sensibility, and 
accomplishes, largely, two cardinal objects : 
minimum duration of treatment and maximum 
freedom from pain. 

It is a fact well attested by clinical observa- 
tion, that the ravages of opium-excess are spent 
mainly on the nervous systems before noted, 
inducing changes that give rise to great ner- 
vous disturbance when the opiate is peremp- 
torily withdrawn — unless some mitigating 
measure be interposed, — and which, even in the 
process of very gradual withdrawal, is seldom, 
if ever, entirely avoided. 

A recital of the varied symptoms of abrupt 
opiate-renouncing is not here needed. Let it 
suffice to say we regard them all, certainly the 
most important — the aches, pains, yawnings, 
sneezings, shiverings, nausea, vomiting, diar- 
rhoea, restlessness, delirium, convulsions, ex- 
haustion, collapse, — as reflex indications of 
great irritation in those centres, and any 
method having the power to counteract and 
control this condition must contribute vastly 
to the patient's comfort and cure. 

Heretofore, two plans have obtained in the 



4 THE TREA TMENT OF OPIUM ADDICTION. 

treatment of opium addiction. One, which 
may well be called heroic, the entire and abrupt 
withdrawal of the usual opiate, invariably gives 
rise to great distress of mind and body, to 
relieve which various remedies are, at the time, 
resorted to. Those not fully informed, and 
desirous of knowing the extent of this suffer- 
ing, which is far from imaginary, as some would 
have us believe, should consult Levinstein's 
work, in which are given details of twenty-four 
cases of hypodermic morphia addiction treated 
by this method, which the author, by a process 
of logic neither safe nor sound, declares to be 
the best. This statement we emphatically dis- 
pute. No treatment that entails such suffering 
as in the cases cited can claim pre-eminence 
over one more humane and equally effective. 
A study of the resultant effects in the instances 
alluded to reveals evidence of dire distress, in 
seven cases so extreme — perilous collapse — 
that a temporary return to hypodermic mor- 
phia became imperative to avert a fatal ter- 
mination. 

The other plan, consisting in a very gradual 
decrease of the usual opiate, meanwhile toning 
up the system to make amends for the accus- 
tomed narcotic, secures the desired result at 



THE TREA TMENT OF OPIUM ADDICTION. 5 

much less discomfort, and we know of no 
reason why it should not be just as permanent. 
It is, however, open to the objection of re- 
quiring a much more protracted treatment — a 
point of importance when time is limited, — 
while it also tends to exhaust the patient's 
patience, and many refuse to continue till suc- 
cess is secured. 

The method we commend is a mean between 
these extremes, and consists in producing a 
certain degree of nervous sedation and conse- 
quent control of reflex irritation by means of 
the bromides, though we refer, specifically, to 
the bromide of sodium, having used that ex- 
clusively in cases under our care. This plan, 
which, so far as we are aware, is original with 
ourselves, is merely a new application of a well- 
established principle, for the power of the 
bromides to subdue abnormal reflex irritability 
is so constant that it may be looked upon as 
an almost invariable sequel of such medication. 
Dr. Ed. H. Clarke, in his valuable treatise on 
the bromides, says : " Diminished reflex sensi- 
bility, however different physiologists may ex- 
plain the fact, is one of the most frequent 
phenomena of bromidal medication that has 
been clinically observed, and is, therapeutically, 



6 THE TREA TMENT OF OPIUM ADDICTION. 

one of the most important." The testimony 
of other observers is to the same effect, Gubler, 
Guttman, Laborde, Voison, Damourette, 
Eulenberg, Claude Bernard, Brown-Sequard, 
and Echeverria, all giving evidence as to the 
power of these agents over abnormal reflex 
action, and at the same time over the general 
nervous system. Admitting that the symptoms 
of opiate-disusing pertain almost exclusively 
to the domain over which the bromides exert 
so decided a control, we have a new field pre- 
sented for the exercise of this valuable power, 
and the fact, proven conclusively by our ex- 
perience, that it does exert this happy effect, 
fully supports the idea advanced as to the 
pathology of this disease. 

In speaking of the bromide of sodium, let it 
be understood that we refer entirely to the in- 
fluence of the continued dose, by which we mean 
its administration twice in the twenty-four 
hours, at regular intervals, so as to keep the 
blood constantly charged with the drug. A 
most important difference exists between the 
effect of this mode of exhibition and that of 
the single dose, or two or three doses so nearly 
together as to form practically one, for, in the 
former case, the system is constantly under the 



THE TREA TMEJVT OE OPIUM ADDICTION. 7 

bromide influence, while in the other, the 
drug being largely eliminated in a few hours, 
the blood is nearly free from it a large portion 
of the time. Results obtainable from the con- 
tinued use cannot be gotten from the single 
dose, and, as a consequence, its value is far 
greater in the disease under consideration. 

Again, the action of the continued dose 
being somewhat remote — three to five days 
usually elapsing before there is decided evi- 
dence in this direction, — much more desirable 
results are secured by its employment for 
several days prior to an entire opium abandon- 
ment, meanwhile gradually reducing the opiate, 
than if the withdrawal be abrupt and then 
reliance placed on the bromide ; for, in the one 
instance, the maximum sedative effect is se- 
cured at the time of maximum nervous dis- 
turbance from the opium removal, and its 
counteracting and controlling influence is far 
in excess of that to be had from its employ- 
ment after the lighting up of the nervous irri- 
tation. What, then, we term preliminary 
sedation forms a peculiar and valuable feature 
in our giving of the bromide, and it is this 
special point we commend, our experience 
having convinced us that we have in it an un- 



8 THE TREATMENT OF OPIUM ADDICTION, 

equalled means of obviating the discomfort 
incident to the treatment of this disorder. 

The value of the various bromides depends 
on their proportion of bromine. Bromide of 
potassium contains 66 per cent, sodium 73, 
and lithium 92 per cent. We should, there- 
fore, expect a more powerful influence from 
the last agent, and, according to Weir 
Mitchell, it has a more rapid and intense effect. 
The sodium, however, answers every purpose, 
and has several points in its favor over the 
other bromides : is pleasanter to the taste, more 
acceptable to the stomach, causes little cuta- 
neous irritation, and much less muscular pros- 
tration. In this connection, recent experi- 
ments and observations by Drs. Ringer and 
Sainsbury on the superior value of the sodium 
salt are of interest, and may be found in the 
British Medical Journal, Mar. 24, 1883. 

Either of the bromides, in powder or con- 
centrated solution, is somewhat irritant, some- 
times producing emesis, and in any event, de- 
laying its absorption. A practical point, then, is 
that it be given largely diluted. Dr. Clarke 
says : " There should be at least a drachm of 
water to each grain of the salt." We give 
each dose of the sodium in six or eight ounces 



THE TREA TMENT OF OPIUM ADDICTION. 9 

of cold water, and have never known it to cause 
vomiting. 

To secure the requisite degree of sedation 
within a limited period, it is essential that the 
bromide be given in full doses. We are con- 
vinced that failure from its use, in any neurosis, 
is very often due to a non-observance of this 
point. Our initial dose of the sodium is 60 
grains, twice daily, at twelve hours' intervals, 
increasing the amount 20 grains each day, 
t. e. y 70, 80, 90 grains, and continuing it 
five to seven days, reaching a maximum 
dose of 100 to 120 grains twice in twenty- 
four hours. During this time of bromidal 
medication, the usual opiate is gradually 
reduced, so that from the eighth to the tenth 
day it is entirely abandoned. A decrease of 
one quarter or one third the usual daily quan- 
tity is made at the outset, experience having 
shown that habitues are almost always using 
an amount in excess of their actual need, and 
this reduction occasions little or no discomfort. 
Subsequently, the opiate withdrawal is more 
or less rapid, according to the increasing seda- 
tion, the object being to meet and overcome 
the rising nervous disturbance by the growing 
effect of the sedative ; in other words, maxi- 



10 THE TREATMENT OF OPIUM ADDICTION. 

mum sedation at the time of maximum irrita- 
tion. 

Exceptions to this may occur. Some pa- 
tients are so weak and anaemic, on coming, 
that a previous tonic course is deemed judi- 
cious ; the usual opiate is continued for a time, 
and, meanwhile, with good food, tonics, and 
other measures, an effort is made to improve 
the impaired condition, and with success, for 
we have seen patients gain markedly in 
strength and weight during this roborant 
regime. 

Sometimes a patient, before placing himself 
under our care, has reduced his daily taking to 
the lowest amount consistent with his comfort. 
If so, the initial large reduction is not made, 
but the decrease is gradual throughout. Again, 
in some instances no reduction is made for two 
or three days, at the end of which the bromide 
effect is secured in part, and the decrease is 
then begun. And in all instances this rule 
governs : each case is a law unto itself y and the 
length and amount of the bromide-giving and 
consequent rate of opiate decrease is determined 
entirely by individ^tal peculiarity as shown both 
before and during treatment. 

Surprise may be expressed and objection 



THE TREA TMENT OF OPIUM ADDICTION. I I 

made re^ardincr the extent of the bromide 
doses, but the fact must never be overlooked 
that we are not to be governed in the giving 
of any remedy by mere drops or grains, but by 
the effect produced. Again, one effect of 
opium addiction is a peculiar non-susceptibility 
to the action of other nervines, necessitating 
their more robust giving to secure a decided 
result. More, under the influence of certain 
abnormal conditions, doses which, ordinarily, 
are toxic become simply therapeutic. The 
annals of medicine abound with instances in 
support of this statement, and among the most 
striking may be noted the following : Dr. 
Southey read before the Clinical Society of 
London notes of a case of tetanus which oc- 
curred in a boy ten years old. The first symp- 
toms of trismus were observed two days after 
a severe fright and drenching due to the up- 
setting of a water butt. They steadily in- 
creased up to the date of his admission to St. 
Bartholomew's Hospital, on the eighth day of 
his illness, when the paroxysms of general 
opisthotonos seized him at intervals of nearly 
every three minutes. Each attack lasted from 
fifteen to thirty seconds, and although between 
the seizures the muscles cf the trunk became 



12 THE TREATMENT OF OPIUM ADDICTION. 

less rigid, those of the neck and jaw were 
maintained in constant tonic cramp. The pa- 
tient was treated at first with chloral, ten 
grains, and bromide of potassium twenty 
grains, every two hours, and afterward with 
the bromide alone in sixty-grain doses every 
hour and a half. When about two ounces 
were taken in twenty-four hours, the attacks 
became less frequent, but at first each separate 
seizure was rather more severe, and on the 
evening of the eleventh day he was able to 
open his mouth better. On the thirteenth day 
the bromide was decreased to twenty grains 
every three hours, and on the fourteenth day 
was discontinued altogether. When the bro- 
mide had been omitted twenty-four hours the 
attacks returned at intervals of an hour, and 
the permanent rigidity of the muscles of the 
neck was re-established. His condition now 
steadily became worse, so that on the eigh- 
teenth day of his illness it became necessary 
to resort to the previous large doses, one 
drachm every hour and a half. After three 
such doses the expression become more nat- 
ural, and he was able to open his mouth again ; 
but it was not until the twenty-fifth day of the 
disease that it was possible to discontinue the 



THE TREATMENT OF OPIUM ADDICTION. 1 3 

remedy. The patient remained in a state of 
remarkable prostration and drowsiness, sleep- 
ing the twenty-four hours round, and only 
waking up to take his food for eight days, and 
passed all his evacuations under him. He 
subsequently steadily and rapidly convalesced. 
The bromide produced no acne or other disa- 
greeable effect, and certainly seemed to exert a 
markedly controlling influence upon the tetanus. 

Surely, under ordinary circumstances, no 
one would think of giving such doses of bro- 
mide ; but here, under the antagonizing influ- 
ence of the intense reflex irritation, their effect 
was vastly beneficial, conducing, beyond ques- 
tion, to the patient's cure. 

Given as we commend, no effect is usually 
noted before the second or third day. Then 
patients mark an increasing drowsiness, which 
deepens into slumber, more or less profound, 
so much so, at times, that it is difficult to re- 
main long awake. With this is a growing 
aversion to active exercise, not solely due to 
lessened muscle force, but largely to mental 
hebetude. Some cases are met with in which 
the hypnotic effect is not very decided, but the 
rule is as stated. Sometimes a saline taste 
and increased saliva with the bromic breath are 



14 THE TREATMENT OF OPIUM ADDICTION. 

noted, and the tongue becomes furred. Acne 
is usually absent. The renal secretion is almost 
invariably largely augmented. We have known 
patients to pass more than one hundred 
ounces in the twenty-four hours, and we have 
noticed this, that where the renal activity is 
not increased, or is diminished, the sedative 
effect of the drug is more prompt and decided. 
The practical point of this is obvious : such 
cases require a less-prolonged bromide-giving. 

With some there is slight transient loss of 
co-ordinating power in the fingers, and, excep- 
tionally, in unusually sensitive subjects, there 
may occur mild startings of the forearm ten- 
dons. These, however, soon subside, and 
their going is largely hastened by local faradic 
seances. 

Another bromide symptom, and a curious 
one it is, relates to a peculiar form of aphasia, 
as shown by using one word for another, — 
Brown for Jones, cake for comb, etc. This 
may persist for several days. Dr. Clarke re- 
fers to several such instances, and says : " They 
are hints of a distinct organ of language, and 
suggest the notion that, inasmuch as the drug 
we are considering paralyzes reflex before it 
does general sensibility, language may be the 



THE TREATMENT OF OPIUM ADDICTION, 1 5 

expression or correlation of a peculiar reflex 
power." 

Another similar symptom is an odd effect on 
the memory, the loss of a word or a sentence, 
and entire inability to regain them at the time, 
so that the train of thought is abruptly 
ended. These, though often amusing, are 
sometimes quite annoying to the patient, but 
possess no other importance, and soon pass 
away. 

Before dismissing this phase of the treat- 
ment we must again insist upon the fact that 
all cases of opium addiction do not require the 
bromide alike. This is a point of prime im- 
portance, and failure to put it in practice is, 
doubtless, often the main secret of ill success 
or unpleasant results in its use. The patient, 
as well as his disease, must be treated, and he 
who uses the bromide, as Fothergill asserts 
Opie mixed his colors — " with brains " — will 
accomplish far more than the tyro who sets 
himself up in the treatment of this or any other 
disorder, and fails to be guided by good judg- 
ment. To follow a mere routine-giving of the 
bromine, or any other remedy, unvaried by in- 
dividual condition, is a sorry showing of pro- 
fessional incapacity. We have lately learned 



1 6 THE TREATMENT OF OPIUM ADDICTION. 

of a case of this kind, presenting a lamentable 
lack of discretion. The patient, a medical 
man, addicted to morphia, having decided upon 
self-treatment, began a plan of operations with 
the bromide, taking it himself for several days, 
and then its hypnotic effect asserting itself, he 
gave orders that it should be given him some 
days longer, and this senseless advice being 
blindly followed by his attendant, he sank into 
a stupor which persisted for more than a fort- 
night. A more indiscreet performance is sel- 
dom heard of, and illustrates anew, in another 
sense, the truth of that trite legal proverb as 
to the mental status of the individual who is 
both lawyer and client. Let it be distinctly 
understood that some cases of opium addiction 
are ineligible for the bromide treatment. Those 
complicated with serious lesion of heart or 
lungs should be excluded, and those in which 
there is marked general debility should always 
be accorded a previous tonic course. Lastly, 
as before asserted, in each and every case where 
it is given, the extent of its continuance is to be 
governed entirely by individual peculiarities as 
indicated both before and during treatment. 

We now desire to call attention to another 
point, which our experience has convinced us 



THE TREATMENT OF OPIUM ADDICTION. I? 

is of value. We refer to the treatment just 
after the habitual hypodermic or other opiate 
is abandoned. Supposing a case where, at the 
end of five to seven days, as individual peculi- 
arity may determine, the desired sedation is 
secured and the usual opiate reduced to a 
minimum — say -J- to ± gr. each dose — in- 
stead of an entire discontinuance, we change 
the order of affairs and make a break in upon 
the routine-taking — the "habit," so to speak — 
by giving one full dose, by mouth, in the even- 
ing. This ensures a sound, all-night sleep, 
from which the patient awakes greatly re- 
freshed, and often quite surprised at his good 
condition, which usually persists during the 
day. The next evening at about the same 
hour, the maximum bromide dose and two 
thirds of the previous opiate are given ; the 
third evening, the same amount of bromide and 
one third the first evening's opiate. This ends 
both opiate and bromide. Exceptionally, the 
full single dose of opium and sodium is given 
only one or two evenings. During the fol- 
lowing day, if the patient be quiet, nothing is 
given. Should there be minor discomfort, one- 
half-ounce doses of fid. ext. coca, every sec- 
ond hour, have a good effect. Cases occasion- 



1 8 THE TREATMENT OF OPIUM ADDICTION. 

ally require nothing else. If, however, as 
usually occurs, despite the coca, the character- 
istic restlessness sets in, we give full doses of 
fid. ext. cannabis indica, and repeat it every 
hour, second hour, or less often, as may be re- 
quired. When the disquiet is not marked, this 
will control. If more decided measures be 
called for, we use hot baths, temp. 105 to 1 12 , 
of ten to twenty minutes' duration, and re- 
peated as required. A short shower or douche 
of cold water often adds to their value. Noth- 
ing equals them for this purpose. Warm baths 
are worthless. The water must be hot — as 
much so as one can bear. We have repeat- 
edly known a patient to fall asleep while in 
the bath. 

And, just here as to " full doses " of the 
hemp. The dose of the books is useless. As 
before stated, addiction to opium begets a pe- 
culiar tolerance of other nervines, and they 
must be more robustly given. We give sixty 
minims Squibbs' fld. ext, repeated as men- 
tioned, and have never noticed unpleasant re- 
sults. Small doses are stimulant and exciting, 
large ones sedative and quieting ; hence the 
latter are seldom followed by the peculiar 
haschish intoxication. And, lest some timid 



THE TREATMENT OF OPIUM ADDICTION. 1 9 

reader should regard this as reckless dosing, 
we hope to calm his fears by saying that the 
toxic power of hemp is feeble, and that these 
doses are the result of an experience of the 
drug in many cases in which smaller ones have 
failed of the desired effect. 

At this writing, two lady convalescents, still 
insomniac, are nightly taking these full doses 
with good effect in securing sleep. One re 
cent lady patient, who did not lose a single 
night's slumber during treatment, and whose 
need for a soporific ended in eight days, took 
no other hypnotic whatever. We have used 
it of late more largely than ever, and with 
growing confidence in its sleep-giving power ; 
taking, in this regard, almost exclusively, the 
place of chloral. 

Regarding this insomnia, Levinstein and 
other German writers assert that it will " re- 
sist every treatment during the first three or 
four days." This may be true with them, con- 
sidering their method, and is, of itself, added 
proof that they are lamentably lacking in the 
therapeutics of this disease. Under the plan we 
pursue no such sleepless state is noted, and in 
ordinary, uncomplicated cases, patients can 
usually be promised recovery without the loss 
of a single entire night's slumber. 



20 THE TREA TMENT OF OPIUM ADDICTION. 

Chloral, during the first four or five nights 
of opium abstinence, fails as a soporific, often 
causing a peculiar excitement or intoxication — 
patients talking, getting out of bed and wan- 
dering about the room — followed, it may be, 
after several hours, by partial sleep. Later, in 
full doses — we prefer 45 grs. at once, rather 
than three 15-gr. doses, — alone, or with a bro- 
mide, it can be relied on as an hypnotic, but we 
have thought that, in some cases, where it se- 
cured sleep, patients, the next morning, felt a 
certain languor, of which it was largely the 
cause. Some who use the hemp mention a 
feeling of fulness about the head and eyes, 
with occasional confusion of thought, but sel- 
dom complain of pain, having noted only one 
such case. 

The bromide, baths, hemp, and coca, with 
or without capsicum — of which more later, — 
are, therefore, the main remedies for the rest- 
lessness and insomnia, two symptoms which, 
with a third, sneezing, are invariable sequelae 
of opium withdrawal, and, wanting which, pa- 
tient is surely deceiving his physician. 

For relief of neuralgic pains in various parts, 
which sometimes occur, varied measures suffice. 
At the head of the list are electricity and the 



THE TREATMENT OF OPIUM ADDICTION. 21 

local application of ether. As to the value of 
the galvanic current in migraine and other 
neuralgiae so common in opium habitues, and 
the manner of using it, the reader is referred to 
papers on "The Prevention of Opium Addic- 
tion, " in the Louisville Medical News, Feb. 23, 
1 884, and Boston Medical mid Stir gical Journal, 
May 7, 1885. The same agent is effective in 
relieving limb and lumbar pains, though here 
a much stronger current is required than can 
be used with safety about the head. Some- 
times a strong faradic current acts well, and 
where one fails, trial should always be made 
with the other. Local hot baths — sitz or foot 
— are often of great service for this purpose. 
Chloroform, locally, relieves ; so, too, massage. 

Regarding the ether, those who have never 
employed it will, we are sure, be surprised at 
its pain-easing power. It matters not how it 
be applied — spray, drop, or lavement — it is po- 
tent for good. 

These three — electricity, ether, hot water — 
are our main anodynes, and one special point 
in their favor is entire freedom from unpleas- 
ant gastric or other results. 

For relief of minor neuralgic pains, other 
remedies, at times, suffice. Croton, chloral, 



22 THE TREATMENT OF OPIUM ADDICTION. 

in ten-gr. doses, every hour, is sometimes quite 
effective in tri-facial disorder. Tonga, one 
drachm of fluid extract, every hour, is often a 
reliable anodyne. Its value in some cases 
seems increased by combining it with the vari- 
ous salicylates. Caffeine or guarana occasion- 
ally relieves. 

Externally, menthol, in solution, two drachms 
to the ounce of alcohol, used with a brush, as a 
spray, or the menthol cone, is sometimes of 
service. So, too, the well-known camphor and 
chloral combination, bi-sulphide of carbon, and 
various minor local anaesthetics. 

Under this plan of treatment, marked disor- 
der of stomach or bowels is rare. Our rule is 
to give an active mercurial or other cathartic, 
at the outset, if there be evidence of alvine 
disorder, and then secure regular action by 
such laxative as is found most agreeable. If 
the latter be so relaxed as to require restraint, 
thirty-minim doses fld. ext. coto, or sixty-gr. 
doses of subnit. bismuth, every two to four 
hours, often serve a good purpose. They are 
best given in capsule. If, however, the diar- 
rhoea persists more than twenty-four hours, the 
most effective measure is to give a full opiate 
— tinct opii., per mouth or rectum preferred — 



THE TREATMENT OE OPIUM ADDICTION. 23 

at bedtime. This promptly controls, gives a 
full night's sleep, and the trouble seldom re- 
turns. Fear of an untoward effect on conval- 
escence is unfounded. With our experience, 
the assertion of one writer that " it is impos- 
sible to cure the opium habit, and bridge the 
patient over the crisis, without having the 
bowels freely relaxed," seems quite absurd. 
We have again and again seen patients recover 
who had only two, three, or four movements 
daily. One such, lately dismissed, was a hy- 
podermic taker of twenty grs. morphia, daily, 
and had been addicted for several years. 
Others have required a laxative enema in less 
than a week after the opiate withdrawal. 

Formerly, an exclusive milk and lime-water 
diet during the first two or three days of opium 
abstinence was deemed advisable. This 
regime is not now imposed, as some patients 
are able to do dietetic duty, and the rule is to 
make no restriction unless the exceptionally 
occurring stomach or bowel trouble seems to 
require. More than one patient, habitues for 
years, did not vomit once. The excessive 
vomiting mentioned by Levinstein and Ober- 
steiner — they practise abrupt disuse — we have 
never noted. The former thinks the collapse 



24 THE TREA TMENT OF OPIUM ADDICTION. 

— which we have never seen — observed in sev- 
eral of his cases was due to the vomiting and 
purging. Probably the largest factor in caus- 
ing it was the exhausting general mental and 
physical suffering which his monstrous method 
entails. 

If the stomach rebels, entire rest, absti- 
nence from solid food, or all food, for a time, 
milk and lime water, or Murdoch's food, in 
small amount, often does well. If more active 
measures be required, sinapisms, ether, fara- 
dism externally, and, internally, bismuth, chloro- 
form, menth. pip., ice, are of value. If all fail, 
a full opiate, hypodermic, will promptly suf- 
fice. 

Having thus crossed the opiate Rubicon, 
treatment relates, largely, to the debility and 
insomnia. For the former, of internal tonic- 
stimulants, coca leads the list. But our ex- 
perience does not warrant Morse's assertion 
— "coca cures the opium habit." That is a 
mistake. While it is of great value in reliev- 
ing the varied symptoms of lessened nerve 
tone, it is not a specific. Patients, long used to 
opium, cannot abandon it and trust to coca 
alone, to carry them over the crisis. This, 
save in mild cases, it will not do, but, conjoined 



THE TREATMENT OF OPIUM ADDICTION. 2$ 

with other measures, it is strong for good. Of 
a reliable fluid extract, we give it sometimes 
before, and always after, the acute restlessness, 
in four- to eight-drachm doses, every two hours, 
or less often as required, and continue in these 
full doses, at increasing intervals for several 
days. As need for it lessens we decrease the 
dose to one or two drachms, and this amount, 
ter die, combined with other tonics, may some- 
times be continued with advantage for weeks. 
As a rule, however, its use is quite abandoned 
within a fortnight Its effect, while noted in 
from three to twenty minutes, seldom persists 
more than two or three hours, so that, when 
the demand for it is active, it is best given at 
this interval. To remove the mental and 
physical depression, the minor neuralgise, and 
the occasionally occurring desire for stimulants 
observed in these cases, nothing equals it, be- 
ing in this regard more nearly a specific than 
any drug at command ; and capsicum, in doses 
of one half to one drachm of the tincture, with 
the coca often adds to its value. 

On the discovery of cocaine, it was thought 
its use, hypodermically, might prove of value 
in the treatment of this disorder, and, on as- 
serted foreign authority, somewhat extrava- 



26 THE TREA TMENT OF OPIUM ADDICTION. 

gant statements were made of its merit in this 
regard ; but repeated trials by the writer have 
failed to prove them, and, in his opinion, it is 
much inferior to a reliable fluid extract of coca. 

Another agent of much service is general 
faradization, twenty-min. seances daily, the 
feet on a plate to which the negative pole is 
attached, while the other electrode, encased in 
a large sponge well wet with warm water, is 
applied to the entire surface, with a current 
strong enough to be thoroughly felt, but not 
painful. This imparts a grateful sense of ex- 
hilarating comfort, and is the most effective 
tonic at command. Thus applied, or with 
anode to cervical spine, it may be used, daily, 
so long as indicated, taking care not to overdo, 
for a current too strong or prolonged works 
mischief, overstimulating and exhausting to 
the extent, it may be, of several days' discom- 
fort, which nothing but time will remove. 
Very exceptionally, faradism disagrees and has 
to be abandoned. 

Alternating with or following we may use 
the galvanic current. This is a general tonic 
of special value in these cases. Our method 
is, positive pole to nape of neck, and negative 
to epigastrium for five minutes ; then the 



THE TREATMENT OF OPIUM ADDICTION. 2J 

former behind the angle of each jaw for one 
or two minutes, making the entire seance of 
seven to nine minutes. 

Next to the electric tonic ranks the cold 
shower bath. It certainly is a great invigo- 
rator, and many a patient who dreads it at first, 
soon comes to appreciate it most highly. If 
agreeing, it should always be taken. With 
some it acts as an hypnotic. We recall one in- 
stance, in particular, of a medical gentleman, 
who, still somewhat insomniac, after sleeping 
two or three hours and awaking with no pros- 
pect of further sleep, would take a shower, 
followed by vigorous rubbing, and soon fall 
into a refreshing slumber lasting till morning. 

Internal tonics, of course, have a place in the 
roborant regime, varied as the case may de- 
mand. In some cases we employ them from the 
outset, and the use of tinct. ferr. mur. in large 
doses — fifteen to twenty min. thrice daily — 
has seemed, in virtue of its tonic-astringent 
effect, to serve a doubly good purpose in less- 
ening the tendency to alvine relaxation. After 
the opiate disuse, an excellent combination is 
fid. ext. coca with syr. hypophosphites iron, 
strychnine, and quinine, two drachms of each 
after meals. Another, Fowlers solution or 



28 THE TREATMENT OF OPIUM ADDICTION, 

tinct. nux vomica with dilute phosphoric acid 
or acid phosphate. If anaemic, ferric tincture 
or Blancard's pills. Digitalis is often useful 
In many cases, cod oil is of value, and may be 
continued for months. We make choice, as re- 
quired, of emulsion with pepsin and quinine, 
emulsion with phosphates, or plain oil. 

Some degree of anorexia is always present, 
yet it may not prevent the regular meal, and 
need never occasion anxiety, for probably it 
will soon give place to a well-marked reverse 
condition, which may be encouraged to fullest 
feeding short of digestive disaster. The appe- 
tite often becomes enormous, and sometimes 
restraint and digestive aid are demanded. If 
it be slow in returning, rousing measures will 
suggest themselves. In such cases it has 
seemed a good plan to stir up the alvine sys- 
tem, once or twice a week for a time, with a 
mild cathartic at bedtime, or a full morning 
dose of hunyadi. 

One result of the opiate-quitting and the 
regime noted is often a greatly improved nutri- 
tion, as shown by a notable increase in weight. 
One physician, not long since dismissed, gained 
a pound a day, and another convalescent has 
lately been adding to his avoirdupois at the 
rate of twelve pounds a fortnight. 



THE TREATMENT OF OPIUM ADDICTION. 29 

Regarding the insomnia, Levinstein says : 
" Sleeplessness, which is generally protracted 
up into the fourth week, is very distressing." 
For reasons before given, his assertion is not 
surprising. Our record differs. Wakefulness 
is an invariable sequel, and requires soporifics 
for a time, but is not so prolonged and does 
not resist treatment. We have known a patient 
able to dispense with hypnotics in five days, 
others in eight, and nearly all within a fort- 
night. Sometimes, they are longer required. 
Two patients, both physicians, during the last 
year, did not regain natural sleep for three or 
four weeks, but this is quite exceptional. 

This insomnia is of two kinds. Most pa- 
tients, after the acute stage has been passed, 
soon secure sleep on retiring, but waken early 
— two or three o'clock, — and fail to get more. 
Others remain awake nearly all night before 
slumber comes, and these are the ones who 
usually require soporifics the longer. 

For the relief of this, cannabis indica, or 
chloral with bromide, in full doses, serves our 
purpose. If, as rarely happens, the wakeful 
state is so pronounced or prolonged, despite 
treatment, as to distress the patient, w r e never 
hesitate to give a full opiate — sub rosa — and 



30 THE TREATMENT OF OPIUM ADDICTION. 

always with good result. In all cases, drugs 
should be dropped soon as possible, and sleep 
secured by a fatiguing walk, or other exercise, 
an electric seance, a Turkish or half hours 
warm bath with cold douche or shower, a light 
meal or a glass or two of hot milk, — one or 
more of these before retiring. 

Patients whose slumbers end early often 
note a peculiar depression on waking, and 
when such is the case, a lunch, milk, coffee, 
coca, or Murdoch's liquid food, should be at 
their command. 

It may be well, in passing, to refer to cer- 
tain minor sequelae and their treatment. Occa- 
sionally a patient complains of dyspnoea, or 
palpitation. We have never noted them 
but twice — both ladies. A stimulant — coca 
with capsicum, or Hoffman's anodyne with 
aromat. spts. ammonia — will promptly con- 
trol. 

Some patients are, at times, annoyed by 
aching pains in the gastrocnemii, that may re- 
cur during several days. Fid. ext. gelseminum, 
in full doses, strong galvanic or faradic cur- 
rents, massage, local hot baths, and topical use 
of chloroform or ether will relieve. 

Others mention a peculiar burning in the 



I 
THE TREATMENT OF OPIUM ADDICTION, 3 1 

soles of the feet, which mustardized pediluvia 
and full doses of quinine usually control. 

Sometimes a dry, hacking, paroxysmal cough, 
more marked at night, may discomfort a pa- 
tient for a time. It can be relieved by nitrate 
of silver spray, ten to twenty grs. to the ounce ; 
a bromide of sodium gargle, sixty grs. to the 
ounce ; or a small blister to the sternum. 

Returning sexual activity, as shown by noc- 
turnal emissions and erections, as a rule, re- 
quires no attention. We once noted, however, 
a case where the awakened virile vigor was so 
marked that repressive measures were de- 
manded. 

The periodical function of females, which, 
usually, is irregular or suspended, has, so far as 
we have observed, required no special after- 
treatment. 

Along with what has been suggested, should 
be such other general hygienic measures as 
will add to the good secured. Patients must 
be given attractive surroundings, cheerful so- 
ciety, diverting occupation and amusement, and 
freedom from care or worry of body and mind ; 
in fact any thing, every thing, that will aid in 
the effort to secure a return to pristine health 
and vigor. That the management of these 



32 THE TREATMENT OF OPIUM ADDICTION. 

cases subsequent to the need of active profes- 
sional care is of great importance, enlarged ex- 
perience increasingly convinces. Neurotic or 
other disorders noted prior to addiction, 
whether genetic or not, must be relieved or re- 
moved. So, too, with those that may first 
appear after the opiate-disusing; and when 
none of these are met, when there is merely a 
lessened power of brain and brawn, ample time 
— months or years, if need be — must be taken 
in which to get thoroughly well, if the chance 
of a relapse would be brought to a minimum. 

It is not to be supposed that a system shat- 
tered by opiate excess will regain its normal 
status within a week or a month, or that a 
premature return to mental or physical labor 
will not imperil the prospect of permanent cure. 
The importance of this must be insisted upon. 
To medical men, who compose so largely the 
better class of habitues, it is especially com- 
mended. Professional work must not be re- 
sumed too soon. The frequency of a narcotic 
return is in reverse relation to the length of 
the opiate abstention, and, as favoring this ab- 
stinence, prolonged rest, change of scene, for- 
eign travel, sea voyages, all have much promise 
of good. 



THE TREATMENT OF OPIUM ADDICTION. 33 

The absence of reference to certain remedies 
which have been mentioned by some as es- 
pecially useful in the treatment of this neurosis 
may be briefly noted. 

Belladonna has been supposed to have a 
special value. We once used it to the extent 
of dry mouth and disturbed vision during the 
opiate withdrawal, but have quite abandoned 
it, for the simple reason that we found, on trial, 
patients did fully as well without it, and the 
freedom from its peculiar effect certainly added 
to their comfort. Whatever its antagonistic 
influence in acute opium-taking, we do not be- 
lieve it possesses any such virtue in the chronic 
form. 

Quinine in large doses, from the outset, or 
grs. two to four, increasing with the opiate re- 
duction, has been thought to have special value. 
We have failed to note it, though as a tonic it 
is well adapted to all cases, and in some pa- 
tients, twenty-gr. doses, as an anodyne or 
soporific, act well. 

Strychnine is another valued tonic, especially 
in a very gradual opiate decrease, or at weekly 
or fortnightly reductions. It has no other 
claim. 

Hydrocyanic acid dilute, aconite, and vera- 



34 THE TREA TMENT OF OPIUM ADDICTION. 

trum viride have been suggested. Why, we 
fail to understand. 

Jamaica dogwood has been commended as 
an opiate substitute, and Morse lauds it ex- 
travagantly. He, however, is an enthusiast, 
and, as such, goes quite too far. 

Regarding its use, he says : " Coca cures the 
opium habit. Jamaica dogwood does more 
than this, it is prophylactic of this disorder. 
By its use the baneful habit is forbidden the 
system." This, we think, is a most mistaken 
opinion. 

And, again : " As an hypnotic, opium is not 
of greater worth/' and, "as an anodyne, opium 
is its only peer." Our experience is entirely 
contrary to any such assertions. We have 
made frequent trial of it ; the results were un- 
even. In a few cases — the minority, — as an 
anodyne it seemed efficient ; as an hypnotic 
it always failed. Morse puts the dose at " fld. 
ext: dose min. v.-xv." Our ill result, certain- 
ly, was not due to the limited quantity, for we 
usually gave it in two-drachm doses. More re- 
cent trials have proved utter failures. One, as 
an anodyne in neuralgia, four one-drachm 
doses, half-hour interval, no relief whatever. 
Another, as a soporific ; six one-drachm doses, 



THE TREATMENT OF OPIUM ADDICTION. 35 

same interval, no sleep. It is a nauseous 
drug, and the aversion to continuing it may 
sometimes account for its failure. Our pa- 
tients, too, may be peculiar, but, be that as it 
may, we have little faith in its value, and now 
seldom employ it. 

Avena sativa has been largely lauded. We 
have given it again and again, in doses large 
and small, in water hot and cold, at intervals 
short and long, and always found it worthless 
— absolutely good for nothing. Bottle after 
bottle has been left with us by those who 
made trial of it in vain, and their experience 
accords with many who have written us, some 
of whom have taken it in ounce doses several 
times daily, and used pounds of it in the trial, 
without good ! ! ! Let no one be beguiled 
into a belief that oats fills the " long-felt 
want." A coming paper will, we think, quite 
disprove its vaunted virtue. 

Hyoscyamia is a powerful drug, and in some 
cases may be of service. We once used it, 
but the need for it now seldom arises. Its 
employment should be limited to patients in 
good general condition, in whom the opiate- 
disusing is attended with unusual insomnia and 
motor activity, In such instances its good 



36 THE TREA TMENT OF OPIUM ADDICTION. 

effect is sometimes surprising, bringing quiet 
and sleep with a promptness and power almost 
startling. We use Merck's amorphous, dose 
tV to 1 of a grain hypodermically. This, 
in these patients, may be deemed the usual 
dose. With some, however, this causes a 
mild delirium without sleep, and in such cases 
the dose must be increased. Regarding its 
safety, Dr. John C. Shaw, Superintendent of 
the Kings County Insane Asylum, has assured 
us that it is largely given in that institution 
with as little fear of ill effects as would attend 
the use of morphia. 

The new alkaloid of Indian hemp, tannateof 
cannabin, commended by German authority, 
proved an entire failure in our hands. 

The latest claimant for professional favor as 
a soporific is paraldehyde. Dujardin-Beaumetz 
lauds it, and claims special value in these cases, 
Our experience does not warrant such state- 
ments. In full doses, 4 to 8 grammes — 60 to 
120 minims — it sometimes brings sleep ; unlike 
chloral, in the early nights of the opium ab- 
stinence it does not excite. In most cases 
both are inferior to Indian hemp. It is best 
given in one half to one ounce of syrup, 



THE TREATMENT OE OPIUM ADDICTION. 37 

flavored with peppermint, ginger, or vanilla, 
and then added to a wineglassful or two of ice- 
water, or in capsule. 

Non-mention of alcoholic stimulants has 
perhaps been noted. We rarely use them. 
The reason is varied. They are seldom called 
for. Very exceptionally, champagne, milk 
punch, or ale may be indicated, but our rule is, 
never to use any form unless imperatively de- 
manded ; and the advice of Levinstein, that 
" those who have an intense craving for alco- 
holic beverages may be allowed to drink wine 
in unlimited quantities," is, we think, positively 
pernicious. As Bartholow says: "When the 
nervous system is losing the loved morphia 
impression it will take kindly to alcohol " ; 
and he adds : "I especially warn the practi- 
tioner against a procedure which the patient 
will be inclined to adopt — that is, to take suf- 
ficient alcohol to cause a distinct impression 
on the nervous system in place of the morphia. 
This must result disastrously, for when the 
alcohol influence expires there will occur such 
a condition of depression that more alcohol 
will be necessary." 

With these opinions we are quite in accord. 
The fact must not be forgotten that some 



38 THE TREATMENT OF OPIUM ADDICTION. 

habitues have used alcohol with morphia ; 
others have taken morphia after addiction to 
the former ; and, in general, habituation to any 
stimulant or narcotic begets a liability to take 
to another in case the original one is aban- 
doned. As a factor in relapse, alcohol-taking 
ranks next to a re-use of opium. The risk, 
then, is obvious, and let the physician beware 
lest, in the effort to aid his patient in escaping 
one peril, he but involves him in another yet 
greater. 

Some details of treatment, apart from the 
strictly remedial, may be of interest. Our rule 
in making the opiate decrease is not to inform 
the patient as to its progress, nor the actual 
time when it is ended. Better tell him when 
days have elapsed since the last dose, and then 
the assurance that so long a time has gone by 
since his enemy was routed will, of itself, be 
an aid in finishing the good work. The in- 
credulous surprise with which this knowledge 
is received by some patients who have made 
frequent but futile efforts to escape, is quite 
notable. 

As regards the manner of taking, a radical 
change is made. If hypodermically, the 
syringe is at once discarded and a sufficient 



THE TREATMENT OF OPIUM ADDICTION. 39 

amount of morphia or opium given by mouth. 
In many cases resort to the morphia or opium 
can be made at once. If so, it should be done. 
If not, their use giving rise to nausea, vomiting, 
or headache, as exceptionally they may, the 
usual method can be resumed for two or three 
days, and then the bromide influence having 
been secured in part, the syringe may be put 
aside, and the opiate used without unpleasant 
effect. 

A German writer some time ago asserted 
that many patients taking more than four 
grains — .25 to .30 gramme — hypodermically, 
daily, will get along fairly well with the same 
amount of morphia by the mouth. We have 
not found this to be the case. On the other 
hand, three times the subcutaneous supply as 
advised by Bartholow is more than enough. 
An increase of one half or double the amount 
will usually suffice. 

Patients may demur to the change, but it 
should be insisted on, for experience has 
proven many points in its favor. In the first 
place, we believe there is, with some, a certain 
fascination about the syringe, which, once 
ended, marks an advance towards success in 
treatment. Many patients come to think that 



40 THE TREA TMENT OF OPIUM ADDICTION. 

the injections are absolutely essential, and to 
convince them to the contrary, as the change 
in taking will, inspires a feeling of gladsome 
relief and larger confidence in a happy re- 
sult. 

Again the staying power, so to speak, of 
morphia or opium by mouth is much greater 
than by subcutaneous taking. Of this there is 
no question. Morphia, hypodermically, is 
more quickly followed by the peculiar effect of 
the drug, which, too, is more decided, but 
earlier subsides, a higher acme sooner reached, 
to decline more rapidly ; whereas, by the 
mouth, or in the form of opium, the rousing 
effect is more slowly developed, but it is on an 
evener plane, and more persistent. Patients 
accustomed to four to eight injections daily, 
will do well on two or three doses by mouth. 
One medical gentleman, now under treatment, 
who had been taking six injections daily, is 
doing perfectly well on one dose of opium by 
the mouth, night and morning. 

As a rule, too, the change in taking brings 
about a marked improvement in the patients' 
condition. We have known them, after using 
the new method a few days, to declare that they 
felt better than for years. In many ways — 



THE TREATMENT OF OPIUM ADDICTION. 4 1 

notably increased appetite and improved alvine 
action — is the change for good. 

Still more, those who quit the syringe, and 
take morphia or opium, usually cross the 
Rubicon of their opiate-disusing with withdraw- 
al symptoms so largely lessened as to make 
this result alone ample reason for the course 
we commend. 

During the decrease, patients are permitted, 
if desired, to continue their frequency of tak- 
ing. As a rule, however, by reason of the 
greater sustaining power of morphia or opium 
by the mouth, it is not required. 

The only restriction imposed is that a certain 
amount shall suffice for twenty-four hours' sup- 
ply, and this is daily decreased, according to indi- 
vidual need, at such a rate as will least likely 
conflict with their comfort. Patients, more- 
over, are always instructed that if the amount 
allowed does not suffice, they are to apply for 
and will be given more. Such being the case, 
no proper motive exists for secret taking, and 
if, despite this liberal proviso, it is indulged in, 
professional relations are suspended. 

This being our plan, it will be inferred, and 
rightly, that we do not subject patients to such 
surveillance as compels their taking a bath, 



42 THE TREATMENT OF OPIUM ADDICTION. 

during which search is made for contraband 
morphia. Nor do we have an attendant " dog- 
ging" their steps during the decreasing regime. 
No person with proper self-respect would sub- 
mit to such treatment without resenting it ; 
and it is not likely to strengthen the confidence 
that should always exist between patient and 
physician, and which, with us, is asked for and 
given. Very seldom is it violated. Patients 
come to us for relief ; they are willing to aid in 
the effort to secure it — those who are not we 
decline to accept — and the result is — success. 

It is sometimes asserted that all opium 
habitues are liars, and that, on presenting 
themselves for treatment, they are always 
equipped with a syringe and a supply. Such 
a sweeping assertion we do not believe — we 
know it is not true. Why, then, should we 
humiliate them after such a fashion, degrade 
them by imposing such detective surroundings ? 
Others may ; we will not, and as yet we have 
no reason to doubt the wisdom of our course. 

Clandestine taking, either before or after 
withdrawal, can always be detected. The 
absence of certain invariable sequelae of an 
honest quitting is positive proof of deception ; 
while the presence of morphia in the urine 



THE TREA TMENT OF OPIUM ADDICTION, 43 

after the time when it should disappear, along 
with other symptoms, furnish added evidence 
beyond dispute. 

It will again be inferred, and also aright, 
that we do not practise any such plan as Lev- 
instein advises when he says : " As soon as 
the patient has consented to give up his per- 
sonal liberty and the treatment is about to 
commence, he is to be shown into the room 
set apart for him for the period of eight to 
fourteen days, all opportunities for attempting 
suicide having been removed from them. 
Doors and windows must not move on hinges, 
but on pivots, must have neither handles nor 
bolts nor keys, being so constructed that the 
patients can neither open nor shut them. 
Hooks for looking-glasses, for clothes and cur- 
tains, must be removed. The bedroom, for 
the sake of control, is to have only the most 
necessary furniture ; a bed, devoid of protrud- 
ing bedposts, a couch, an open wash-stand, a 
table furnished with alcoholic stimulants, cham- 
pagne, port wine, brandy, ice in small pieces, 
and a tea urn with the necessary implements. 
In the room, which is to serve as a residence 
for the medical attendant for the first three 
days, the following drugs are to be kept under 



44 THE TREATMENT OF OPIUM ADDICTION. 

lock and key : a solution of morphia of two per 
cent, chloroform, ether, ammonia, liq. ammon. 
anis, mustard, an ice-bag, and an electric in- 
duction apparatus. A bathroom may adjoin 
these two apartments. During the first four 
or five days of the abstinence, the patient must 
be constantly watched by two female nurses." 

Now what means this rigorous regime? 
First, that the lack of efficient medical meas- 
ures makes essential physical force. Second, 
that the method employed entails such distress 
of mind and body as to risk a suicidal ending ; 
and that a great calamity always impends — 
collapse that threatens life, and demands that 
the doctor be closely at hand to avert the 
dreaded danger ! 

In strong contrast with what has been 
quoted, during our opiate withdrawal patients 
are not only permitted but encouraged to go 
out and about, attend entertainments, and en- 
gage in social domestic pleasures ; and this is 
continued throughout treatment, save a tran- 
sient suspension following the first twenty-four 
hours of opium abstinence. After the first day 
of opium-disusing, patients are, for a time, 
under careful attention, and, if required, an 
attendant is with them, but the need for ser- 



THE TREATMENT OF OPIUM ADDICTION. 45 

vices of this sort is, usually, quite limited, and 
in some instances entirely dispensed with. 
Again and again have patients presented, who 
fully expected the rigorous regime imposed by 
Levinstein, but who were happily surprised to 
find it was not demanded, and who were fully 
convinced, before their treatment ended, that 
it was not at all essential. 

As between this method and the barbarous 
plan of those who counsel and compel heroic 
withdrawal, "comparison is odious." 

In this day of advanced therapeutics, the 
writer holds radical opinions as to the utter in- 
excusability y the positive malpractice of subject- 
ing patients of this class to that torture of mind 
and body the German method entails. It is 
wrong, grievously wrong ; more, it is cruel to 
demand that they shall run the gauntlet of 
such suffering. 

In various papers we have expressed our 
views on this important part of the subject, and 
enlarged experience tends only to confirm 
them. More and more pronounced is our be- 
lief " that no physician is warranted, save under 
circumstances peculiar and beyond control, in 
subjecting his patient to the torturing ordeal 
of abrupt withdrawal. We are well aware that 



46 THE TREATMENT OF OPIUM ADDICTION. 

it has the sanction of men otherwise eminent 
in the profession, but we venture to suggest, 
with no lack of respect to these gentlemen, 
that theory is one thing, practice another, and 
we are quite certain, were they compelled to 
undergo the trial, there would be a rapid and 
radical change of opinion. We regard it as 
cruel, barbarous, utterly unworthy the healing 
art' 

" We care not who advocates it, but speak 
feelingly, emphatically, and advisedly on this 
point, for the simple reason that our experi- 
ence, again and again repeated,proves beyond all 
dispute that the opium habitue can be brought 
out of his bondage without any such crucial 
suffering as this method of treatment entails." 

Bartholow says : " Having had one experi- 
ence of this kind, I shall not be again induced 
to repeat it, if for no other, for strictly humani- 
tarian reasons, since the mental and physical 
sufferings are truly horrible." 

For proof of this and more in detail, the 
reader is referred to papers by the writer : 
"J Clinical Notes on Opium Addiction," Cin- 
cinnati Lancet and Clinic, March 3, 1883; 
" Neurotic Pyrexia with Special Reference to 
Opium Addiction," New England Medical 



THE TREATMENT OE OPIUM ADDICTION. 4 J 

Monthly, June, 1883; "The Treatment of 
Opium Addiction," St. Louis Courier of Medi- 
cine, June, 1883; and "A Personal Narrative 
of Opium Addiction, " New York Med. Gazette, 
July 7, 1883. 

More, many unaware that a more humane 
method is at command, and dreading the 
ordeal of abrupt disusing, refuse to accept it, 
and, continuing their narcotic, bind all the 
more closely " the web that holds them fast as 
fate." During the past year, a medical gentle- 
man nine years addicted to morphia came 
under our care. Six years ago he first con- 
sulted us. During this time he had read 
Levinstein's book, and the dread of such suf- 
fering as that authors patients underwent was, 
he avowed, the reason for his delay in making 
an effort to quit the morphia. Finally, sum- 
moning sufficient courage — though not without 
much apprehension — the trial was made, and 
with the most gratifying success, for, greatly to 
his surprise, and pleasure, he made a notably 
good recovery with so little nervous disturb- 
ance that not a single bath was called for, and 
with such freedom from pain that not once was 
an anodyne demanded, and was dismissed on 
the twenty-sixth day of his treatment. Com- 



48 THE TREA TMENT OF OPIUM ADDICTION. 

meriting on his case, he declared the manner of 
his recovery seemed "almost miraculous," and 
asserted that, had he ever thought so much 
could be accomplished at so little cost of time 
and discomfort, his effort, years earlier, would 
have been made ; and in a recent letter he wrote : 
" My own swift and easy passage of that ' one 
more river to cross/ is an ever-recurring source 
of wonder and astonishment to me, and not a day 
passes, not a morning comes, without a keen 
sense of exultation at my escape from the old 
slavery, a blessed freedom from the old self- 
accusing conscience, and a return of the old 
instinctive habit of looking every man straight 
in the eyes ! I think I shall never entirely get 
rid of a certain shadow of the past ; nearly 
nine years of mental distress, which I thought 
wellnigh hopeless, must leave a deep and 
ugly scar at my time of life, but thank God 
that I have only the scar to trouble my memory, 
and not the festering, corroding, ever-present 
ulcer which made me unspeakably wretched, 
and kept me in continual fear of discovery. " 

Before closing, let it be noted that this, 
beyond question, is a vincible disease, and re- 
assert — vide " Opium Addiction among Medical 
Men," — that " repeated experience warrants the 



THE TREATMENT OF OPIUM ADDICTION. 49 

assertion that every case of opium addiction free 
from organic disease, and in which there is an 
earnest desire to recover — be the extent and 
duration what it may — admits of prompt and 
positive relief." 




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